Comparison of high and low sodium bicarbonate and acetate dialysis in stable chronic hemodialysis patients.

Eight stable center dialysis patients completed four, 10-week study periods in which either acetate or bicarbonate dialysis was used, each with high or low sodium concentration. During high sodium dialysis, blood pressure was better controlled, weight loss more easily tolerated and dialysis was most satisfactory from the patient's point-of-view with regard to dialysis-associated symptoms. Low sodium dialysis, whether with acetate or bicarbonate, was less satisfactory. In contrast to the beneficial effect of an increased sodium concentration, the use of bicarbonate instead of acetate appeared to make little difference either to the patient's symptoms, to the control of blood pressure or to changes in blood gases or biochemistry. Careful choice of dialysate sodium concentration appears to be important in lessening dialysis side-effects. Substitution of bicarbonate for acetate in chronic stable dialysis patients has comparatively little benefit and the choice can legitimately be made on the basis of cost and technical considerations.